Each Shot of Satisfaction is related to one of the seven steps in the process of REFLECT. My hope is that, by sharing with you how I apply these steps in my daily life, it will help you on your journey to a fulfilling life of caregiving.
In this weeks Shot of Satisfaction video, Dr. Frank Gabrin, the author of Back from Burnout, talks about the pain we feel when we lose a patient and shares why it’s important for our own wellbeing to step deeper into our connection with those they leave behind.
Step 3 – FORMULATE YOUR PLAN for getting the satisfaction you crave, the fulfillment that comes from caring. Recalculate the transaction of care using the “Perfect Equation.” You giving, and your patient’s receiving, True Care adds up to the energy of real and lasting satisfaction in the quantum world of thought and emotion. Free yourself from your (hidden) agenda; the thank you, the kudo, or even the “5” on the Press Ganey Survey they will be receiving in the mail next week. The good feelings you want can only come from freely giving care to your patient without the expectation of anything in return. The only reason to care is because it feels good and giving care allows us to live our lives at the intersection of meaning and purpose.
Hardwired to Care
Working in the Emergency Department is challenging always, no matter who you are or what position on the team you play. This past week, the volume and the acuity were both very high, and as weeks go, this one was more challenging than most. As the days went on, I found myself struggling emotionally; low energy, low enthusiasm, and happiness seeming very far away and tough to access.
When the volume gets high, and the acuity makes things more complex, I often times find it difficult to get away from the phone calls and the computer work that is necessary to coordinate medical care for my patients. This makes it more difficult for me to spend time at the bedside. Often I have to rely on nurses and techs to get information to my patients that I can not deliver myself.
Seeing the why
Reflecting back on the past week, I realized that the reason I began to fatigue emotionally was because I was not making the effort to spend more time at the bedside in connection with my patients and their families. Delivering the intangible thing called care is a process. If I want to feel good as a result of that process, I have to complete, or go through all stages of the process.
I recognized that I have developed a negative pattern that I default to, especially when I start to feel overwhelmed at work: I get preoccupied with myself and what I have to do. While I make a strong effort in the beginning to connect to my patients and let them know that I will do everything I can to help them, when the results come back, and it time to administer the treatments and make disposition, I often fail to get back to the bedside to let them know what is going on and what will happen next.
Inevitably, when this is happening, nurses come to me to let me know that the patient or their family would like to see me before they go home or upstairs to an impatient bed. I am already feeling like I am being pulled in a thousand different directions, and almost always feel overburdened by making the trip back to the bedside. So when I get there, I give them very tangible information about their situation but I almost always miss the opportunity to complete the intangible process of caring for them. When I do this, the one I hurt the most, is myself.
Completing the process
There is a big difference between empathy and compassion emotionally. When I first meet the patient, when any of us meet the patient, we automatically empathize with them. We can’t help it. It is part of our basic human physiology. We are hardwired to empathize. But empathy is a state of shared suffering. A state were we feel the pain, emotional or physical, the angst and the confusion of our patient.
Without staying in connection with my patient, and making the conscious effort to move from the state of empathy where I feel bad for them, to the state of compassion, where I want only the best for them, for them to feel better and be better, I remain in their suffering. I can only escape these negative emotional effects if I move out of empathy into compassion and take action by saying or doing something the will make things better for them. I can only do this if I make the effort to get back to the bedside to complete the encounter by completing the process. I can only feel better through generating compassion and taking compassionate action.
The process of True Care
So for all of us, it is important to remember that if we want to feel the satisfaction that is available from our efforts to care for another, we can only feel better ourselves if we move through the entire process. Here is the process we can move through in the energetic world of human thought and emotion in order for our care to be effective and mutually satisfying. There are six steps to the mindful process of generating true care.
1. Presence: Show up and get fully present. Look at the thoughts going on inside your head and put aside the ones that don’t have to do with what’s going on right now—those distracting thoughts of the work that’s waiting for you or unfinished business at home. Now focus on the patient in front of you. Give him or her your full and undivided attention.
2. Connection: Connect with your patient. Introduce yourself and ask the patient’s name. I often ask patients to tell me something about themselves that will help me remember who they are. Sometimes I shake their hand or touch their shoulder. I make eye contact as I ask what’s going on with them, how are they feeling, where is their pain?
3. Focus: Make your patient’s needs your focus. Put his fears, concerns and needs in front of your own. Show him some real human dignity. Remember, you are human too, and both of you deserve human dignity and human kindness.
4. Empathy: Start to imagine what this situation is like for her, what it would be like to walk in her shoes. Feel your patient’s pain as if it were your own. Stay in this uncomfortable empathetic place with her until you feel things change—without offering to fix anything.
When your patient recognizes that you are feeling, at least to some extent, what he or she is feeling about the situation—that you understand the anguish or pain, something shifts in the quantum energies you are sharing. It shifts for you both, and you will sense it—or perhaps even hear or see it: a sigh, a sob, a relaxation of breathing, a softening of a fretful look, a slowing of the pulse.
5. Compassion: Now, you make the conscious decision to leave this painful place you share with your patient by turning on your own compassion. Feel your own desire for things to be better for them; for them to feel better, for the pain to lessen, their fear to dissipate, their anguish or their despair to soften. You do not yet speak or do anything. You just be. You are still only working with your thoughts and emotions, using your heart and mind.
This stage of the process will enlarge you, energize you and empower you. This is where the transaction of care occurs. This is where your mind affects matter, specifically the grey matter in your prefrontal cortex, and all the dopamine-rich feel-good life-enhancing centers light up like a Christmas tree on real-time MRI scanning.
You are in effect using your heart and mind to generate the Milk of Human Kindness (a special recipe of neurotransmitters) in your own brain, and this process, somehow, most probably through the scientific principle known as resonance, makes you and your patient both feel better.
This stage of the process is where you get to feel on a visceral level that you care, that what you do matters, that you make a difference and that you matter. This is the cure for your own compassion fatigue and (if compassion fatigue is left untreated too long) for your ultimate professional burnout.
6. Action: Finally, once you feel full of your own compassion, move on to the practical physical matters that will help make your patient’s situation better or at least more tolerable.
If you are feeling drained and depleted, ask yourself, are you completing the transaction of care? Are you making the effort to move past the pain of empathy to the joy of compassion? Take a look at the six steps above and remember care is a process and for it to be effective we can only hope to feel better is we move through all six stages, and this takes real effort, especially when we are already feeling overwhelmed.
This week make the effort to do better, feel better and be better through the process that ends with compassion and compassionate action.
Care, make a difference and change (y)our world-
Frank D. Gabrin, D.O
Back from Burnout: Seven Steps to Healing from Compassion Fatigue and Rediscovering (Y)our Heart of Care
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